Lessons From Abroad: International Efforts to Improve Quality, Reduce Costs and Increase...

Lessons From Abroad:

International Efforts to Improve Quality, Reduce Costs and Increase Transparency

Robert S. Galvin, MDBipartisan Congressional

Health Policy Conference

January 13, 2007

2 Robert S. Galvin

Bipartisan Congressional Health Policy Conference

January 13, 2007

Lessons From AbroadWhere The U.S. Is Different

• Much Larger, More Heterogeneous Population

• Health System Much Less Centralized…By Design(?)

- Federal vs. State vs. Private Sector

• No Consensus On How To Control Costs

• Very Medical Innovation-Technology “Friendly”Where The U.S. Is Most Similar

• Common Belief: Driving Value vs. Cost Containment

3 Robert S. Galvin

Bipartisan Congressional Health Policy Conference

January 13, 2007

U.S. Has Been Improving Quality…Slowly

4 Robert S. Galvin

Bipartisan Congressional Health Policy Conference

January 13, 2007

Strategic Framework Board - 2003

Professional Organizations

Care Delivery Teams

PATHWAY #2

Goals

Purpose

Results(Performance)

Improvement

Consumers

Purchasers

PatientsMotivation

PATHWAY #1

Selection + Payment

Hospital Death Rate (RAMR)

Columbia Presbyterian 3.93*

Lenox Hill 2.26

NYU Hospitals Center 1.95

Weil Cornell – NYP 0.95*

Surgeon RAMR

State Total 2.25

Smith, C 4.15

The Power Of Transparency

6 Robert S. Galvin

Bipartisan Congressional Health Policy Conference

January 13, 2007

Payment and Improvement

“Current Payment

Systems . . . Are at Best

Neutral and at Worst

Negative Towards Quality”

MedPAC 2004 (2004)Institute of Medicine (2001)

“If I keep getting better, Dr Galvin,I’m going to improve myself

right out of business”

Glen Hackbarth

“Purchasers should…Remove

Barriers that…Impede Quality

Improvement

And Build In Stronger Incentives

For Quality Enhancement”

Immutable &

Desirable

AgeingTechnology

Unhealthy LifestylesMalpracticeEnd of Life Care

Cultural

System of

Care

UninsuredAdministrative CostsHigh Prices/Specialist IncomesWaste and Quality ShortfallsLack of Accountability/Transparency

Health Costs: Lots of Opportunity, Little Focus